Surgical manipulation of the extraocular muscles in an integral part of the management of strabismus. Currently the success rate, as defined as within 10 prism diopters of alignment, is approximately 70-75% in uncomplicated congenital esotropia. Success rates decrease in more complicated forms of strabismus with paralytic or fibrotic components. The single greatest obstacle to improved accuracy is an inability to precisely predict the results of the surgery performed at the operating table, under anesthesia. The purpose of the proposal is to study the use of succinylcholine intraoperatively as a predictor of post operative alignment. In a heterogeneous population, a recent study demonstrated a 99 +/-10 percent correlation between the awake pre-operative alignment and the succinylcholine induced ocular position under anesthesia. Our preliminary data, in a homogeneous population of esotropes, have demonstrated a .98 correlation coefficient (p. 10 to the minus 6) between the post operative alignment at one week and the post-surgical, succinylcholine induced ocular position under anesthesia. The major objective of this study will be to define by regression analysis the relationship of the succinylcholine predicted position under anesthesia to the post operative awake alignment in various, defined subgroups of strabismus patients, in the initial post op period. Additionally, the actual alignment at 1, 6, 24 and 50 weeks will be compared to that predicted by the succinylcholine induced ocular position. Likewise the desired post operative position as calculated pre operatively from the standard tables for guidelines in strabismus surgery, will be compared with these actual measurements. Reliability of the drug predicted values as compared to the predicted response from published guidelines will be performed. The ultimate goal is to develop an objective system for improved success rates, and therefore fewer hospitalizations and lower hospital costs per patient, in the management of strabismus.